Provider Demographics
NPI:1700819141
Name:LOPEZ-BAEZ, SANDRA I (PHD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:I
Last Name:LOPEZ-BAEZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 EMMET ST S
Mailing Address - Street 2:ROOM 150
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-2424
Mailing Address - Country:US
Mailing Address - Phone:434-924-7034
Mailing Address - Fax:
Practice Address - Street 1:405 EMMET ST S
Practice Address - Street 2:ROOM 150
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-2424
Practice Address - Country:US
Practice Address - Phone:434-924-7034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003380101YM0800X
VA0810004096103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA12093636OtherCAQH